Emergency department utilization during the first year of life among infants born to women at risk of disability

Abstract

BackgroundWomen with disabilities are at risk for poor birth outcomes. Little is known about longer-term health and healthcare utilization of infants of women with disabilities. ObjectivesWe identified women at risk for disability and evaluated their infants’ emergency department (ED) utilization during the first year of life. Study designThis population-based cohort study used Massachusetts 2007–2009 birth certificates linked to 2007–2010 hospital discharge data. Access Risk Classification System categorized ICD-9 CM/CPT codes into disability risk categories. Infant ED visits were evaluated overall and by severity (emergent/intermediate vs. non-emergent). Cox proportional hazards models provided adjusted estimates. Results were stratified by gestational age (preterm, < 37 weeks, term, 37 + weeks). ResultsOf 218,599 women, 6.7% were at risk of disability. Infants born to women at risk had a higher rate of ED visits in their first year than infants born to women not at risk: 0.85 visits/person-year (95% CI 0.84–0.87) vs. 0.55 (0.55–0.55) for term, 0.74 (0.70–0.77) vs. 0.55 (0.54–0.56) for preterm. Utilization varied by maternal diagnosis. Emergent/intermediate and non-emergent visits were both elevated among infants born to women at risk for disability. In adjusted analyses, term infants of women with musculoskeletal diagnoses (HR = 1.3, 95% CI 1.2–1.4) and preterm infants of women with circulatory diagnoses (HR = 1.2, 1.0–1.3) had the highest hazards of ED visit vs. infants of women not at risk of disability. ConclusionMaternal disability risk is associated with postnatal infant ED utilization; utilization varies by maternal diagnosis. Interventions to improve health of infants born to women with disabilities are warranted.